UBC Eye Doctors Establish African Centre

By Catherine Loiacono

To Dr. Paul Courtright, improving the lives of others means taking a hands-on approach to reducing blindness in Africa.

An ophthalmic epidemiologist in UBC’s Department of Ophthalmology, Courtright studies the prevalence of eye disease among populations. Working in Africa, he has found there are many community issues that contribute to increased blindness – particularly for women.

“Research shows that women represent two-thirds of blind people in the world,” says Courtright. “The high rate of blindness among women in Africa is as much of a societal issue as it is a need for adequate resources. For example, the social standing of women often prevents them from seeking treatment.”

Courtright adds that women in some of these countries do not have decision-making authority within families and communities. This limits their access to surgical services, and the health care systems do little to enable individuals to come in and get treatment.

According the World Health Organization the leading causes of chronic blindness include cataract, glaucoma, diabetic retinopathy, trachoma, and eye conditions in children. Three-quarters of all blindness can be prevented or treated.

Courtright’s passion for research and treating blindness led to the establishment of The British Columbia Centre for Epidemiologic and International Ophthalmology (BCEIO) in 1995 at UBC. The centre is an international advocacy and teaching program that focuses on building local capacity to prevent and treat blindness, and provides teaching in research methods and data management.

“The BCEIO is instrumental in developing research and training tools,” says Courtright. “However, to truly have an impact and to enable change we needed to be on the ground working with local providers and communities and applying what we are learning.”

His family moved to Moshi, Tanzania, and with help from the BCEIO and Seva Canada Courtright and his wife, Dr. Susan Lewallen, also an ophthalmologist at UBC, established the Kilimanjaro Centre for Community Ophthalmology (KCCO) in 2001.

“We are working at it from both ends, from a community perspective and from a healthcare provider perspective,” says Lewallen. “At KCCO, we are not training surgeons, but rather we train people on how to set up programs that support the surgeons in accomplishing their work. Surgeons on their own really can’t do much -- they need to be supported by a team that keeps the clinic running smoothly and conducts outreach to bring patients in from the rural communities.”

KCCO is the only training institution for community ophthalmology in Africa dedicated to reducing blindness. It serves 18 eastern African countries with a population of close to 210 million, from Egypt to South Africa. KCCO directs critically needed projects and collaborations to bring eye-care treatment and preventative services to surrounding rural communities.

“The demand for training has grown so that doctors and other eye care professionals have come from countries across the continent - Ghana to Eritrea to Madagascar,” says Courtright. “Some of the programs assisted by KCCO have seen two and three-fold increases in eye care services provided. Our work has already demonstrated that the number of cataract surgeries in programs serving rural communities can be increased by 300 per cent.”

One of the projects, in collaboration with the BCEIO, involves selecting local female leaders who are trained in eye conditions and simple promotion techniques. They are asked to visit households, meet with and counsel family members and refer people in need of eye care services.

To address blindness in children, the KCCO and BCEIO set up a program for getting children to hospital and ensuring adequate follow up with glasses and low vision care.

“The most significant development during the last two years was expansion of a community-based program to provide long-term post-operative care for children with cataracts,” says Ken Bassett, professor and division head of the BCEIO.

The next step for Courtright is to bring blindness and gender issues to the forefront of the international agenda. He, along with other colleagues, will be participating in a meeting with other international leaders in Washington, D.C. next spring.

“In many ways treating blindness has become a tool and entry way into the system,” says Courtright. “We are definitely making an impact on reducing blindness. But really, we want to change systems beyond eye care services -- primarily at the health provider level but also at the community level.”

The work of Courtright and Lewallen has not gone unnoticed. The world’s largest association of eye care professionals, the American Academy of Ophthalmology, awarded them the 2008 International Blindness Prevention Award.